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Clinical Toxicology

Ian M Paul, Kate M Reynolds, Jody L Green
BACKGROUND: Until recently most of the scrutiny of opioid-containing cough and cold medications (CCMs) by the US Food and Drug Administration (FDA) was focused on codeine, only recently shifting equal focus to those containing hydrocodone. We characterized adverse events (AEs) in children <12 years old associated with CCMs that include both an opioid and over-the-counter (OTC) ingredient. METHODS: US cases from multiple sources collected as part of a safety surveillance program were included if AEs followed exposure to combination CCMs containing codeine or hydrocodone between January 2008 and December 2015...
April 10, 2018: Clinical Toxicology
Tharwat El Zahran, Aaron Ralston, Alexandra King, Diane Hindman, Brent W Morgan
CONTEXT: Across the world, tobacco is used in a variety of forms, including being smoked or added to a "quid" that is then chewed. We report a case of lead poisoning in a child from tobacco imported from Thailand. CASE DETAILS: A 12-year-old Thai immigrant boy had a blood lead level (BLL) of 6 mcg/dL on routine testing upon arrival to the United States, but which increased to 72 mcg/dL six months after his arrival. He was asymptomatic with unremarkable workup...
April 6, 2018: Clinical Toxicology
S L Calcaterra, S G Severtson, G E Bau, Z R Margolin, B Bucher-Bartelson, J L Green, R C Dart
CONTEXT: Prior works demonstrates an increased risk of death when opioid analgesics and benzodiazepines are used concomitantly to gain a high. Using poison center data, we described trends in abuse or misuse of benzodiazepines and opioid analgesics. We quantified mortality risk associated with abuse or misuse of benzodiazepines, opioid analgesics and the combination of opioid analgesics and benzodiazepines. METHODS: This was a retrospective chart review of data from the National Poison Data System which collects information from 55 poison centers located across the United States...
April 3, 2018: Clinical Toxicology
Kai Li, Howard Horng, Kara Lynch, Craig G Smollin
CONTEXT: Kambo cleanse is a purification, cleansing ritual traditionally performed by South American shaman to confer luck and health to hunters. CASE DETAILS: We report a patient who presented to the emergency department with prolonged symptoms of vomiting, flushing, facial swelling, altered mental status, and agitation requiring chemical restraints, 22 h after a Kambo cleanse. The patient was found with four small, circular, superficial burns to the ankle at the site where the resin was introduced...
April 2, 2018: Clinical Toxicology
Hannah Hays, Michael C Beuhler, Henry A Spiller
No abstract text is available yet for this article.
April 2, 2018: Clinical Toxicology
Jiri Hlusicka, Tomas Loster, Lucie Lischkova, Manuela Vaneckova, Zdenek Seidl, Pavel Diblik, Pavel Kuthan, Pavel Urban, Tomas Navratil, Petr Kacer, Sergey Zakharov
CONTEXT: The role of activation of lipid peroxidation in the mechanisms of acute methanol poisoning has not been studied. OBJECTIVE: We measured the concentrations of lipid peroxidation markers in acutely intoxicated patients with known serum concentrations of methanol and leukotrienes. METHODS: Blood serum samples were collected from 28 patients hospitalized with acute intoxication and from 36 survivors 2 years after discharge. In these samples, concentrations of 4-hydroxy-trans-2-hexenal (HHE), 4-hydroxynonenal (HNE), and malondialdehyde (MDA) were measured using the method of liquid chromatography-electrospray ionization-tandem mass spectrometry...
April 2, 2018: Clinical Toxicology
Genta Yamada, Marin Takaso, Masateru Kane, Satoshi Furukawa, Masahito Hitosugi
No abstract text is available yet for this article.
March 28, 2018: Clinical Toxicology
D Nicholas Bateman, Victoria Eagling, Euan A Sandilands, Gill Jackson, Catherine Crawford, Leonard Hawkins, Ted Cheung, Gillian Cooper, Sally M Bradberry, John P Thompson, Simon H L Thomas, Michael Eddleston
BACKGROUND: Iron poisoning is potentially serious, but mortality has fallen worldwide since implementation of pack size and packaging restrictions, and changes in iron use during pregnancy. The management of individual cases of overdose remains problematic due to uncertainty about indications for antidote. We examine the epidemiology of iron overdose in hospital cases referred to the UK National Poisons Information Service (NPIS) and evaluate the toxicokinetics of iron in patients ingesting only iron preparations...
March 28, 2018: Clinical Toxicology
Elie Harmouche, Robert S Hoffman, Mary Ann Howland
No abstract text is available yet for this article.
March 26, 2018: Clinical Toxicology
Anselm Wong, Benjamin Cheung, Charlotte Nejad, Michael Gantier, Andis Graudins
CASE DETAILS: A 19-year-old girl presented to the emergency department following overdose of 10 g of paracetamol on a background history of cystic fibrosis. Paracetamol concentration was below the nomogram line, but was treated with acetylcysteine seven hours post-overdose given her symptomatology. Nineteen hours following her overdose she developed hepatotoxicity, despite early initiation of acetylcysteine. She was discharged well six days post-ingestion. On presentation, delta miRNA-122-miR483 was 20 times that of control patients, however, alanine aminotransferase was normal...
March 22, 2018: Clinical Toxicology
Laurie A Willhite, Benjamin A Willenbring, Benjamin S Orozco, Jon B Cole
No abstract text is available yet for this article.
March 22, 2018: Clinical Toxicology
Miran Brvar, Ming Yin Chan, Andrew H Dawson, Richard R Ribchester, Michael Eddleston
INTRODUCTION: Treatment of acute organophosphorus or carbamate insecticide self-poisoning is often ineffective, with tens of thousands of deaths occurring every year. Researchers have recommended the addition of magnesium sulfate or calcium channel blocking drugs to standard care to reduce acetylcholine release at cholinergic synapses. OBJECTIVE: We aimed to review systematically the evidence from preclinical studies in animals exposed to organophosphorus or carbamate insecticides concerning the efficacy of magnesium sulfate and calcium channel blocking drugs as therapy compared with placebo in reducing mortality or clinical features of poisoning...
March 20, 2018: Clinical Toxicology
Donna L Seger, Justin K Loden
CONTEXT: Following clonidine ingestion, naloxone is seldom administered as it is considered ineffective in reversing somnolence, bradycardia, or hypotension. However, this conclusion has been based on administration of small doses (2 mg or less) of naloxone. The somnolence is frequently treated with endotracheal intubation (ETI), a procedure with significant morbidity. OBJECTIVE: We aimed to determine if naloxone administration reversed the effects of clonidine or caused any adverse effects...
March 16, 2018: Clinical Toxicology
Jeremy Brice Bitton, Josh Jiaxing Wang, Winnie Teng, Eric Villeneuve, Sophie Gosselin
No abstract text is available yet for this article.
March 14, 2018: Clinical Toxicology
Beata Halassy, Tihana Kurtović, Maja Lang Balija
No abstract text is available yet for this article.
March 9, 2018: Clinical Toxicology
Wen-Jun Liu, Wei Li, Yang Tang, Si-Jie Gao, Fang Fang, Feng Xu, Ye Xu
CONTEXT: Soft tissue calcifications (STCs) were incidentally found in some of the Hymenoptera-stung (HS) children when they underwent computed tomography (CT) scans for evaluating complications of vital organs. Afterwards, a predilection of STCs to the children with severe complications was clinically noticed. A hypothesis was then developed that STCs secondary to HS may correlate with poor outcomes. OBJECTIVE: This study aims to firstly characterize the CT findings of STCs in HS children and to confirm our hypothesis that the occurrence of STCs may act as an indicator of poor outcomes in HS children...
March 9, 2018: Clinical Toxicology
Géraldine Meyer, Florence Jegou, Jean-François Hamel, David Boels
AIM: Accidental inoculation of humans with veterinary vaccines can lead to early and late complications. The aim of our study is to describe these complications and their risk factors. METHODS: Prospective observational study conducted from 2007 to 2014 at Angers University Hospital's Poison Control Centre. The endpoints examined were: early and late locoregional complications, surgical treatment, and absence from work. The statistical analysis was based on a multivariate analysis...
March 8, 2018: Clinical Toxicology
John Henry McDermott, Charles Reynard, Jonathan Perry, James W Dear, Fran Child, Rachel Jenner
BACKGROUND: Recent public health strategies have contributed towards a significant reduction in the incidence of carbon monoxide (CO) poisonings. When events do occur, symptoms can vary dramatically depending on the carboxyhaemoglobin level and individual factors. Most reports to date focus on individual cases or larger retrospective reviews of diverse cohorts. There are very few reports of CO exposure related to scuba diving activities. METHODS: We describe the clinical sequelae experienced by 10 children who were exposed to CO during a scuba diving lesson...
March 8, 2018: Clinical Toxicology
Senanayake A M Kularatne, Seyed Shahmy, Shantha S Rathnayake, Andrew H Dawson
OBJECTIVE: Arthropod stinging and bites are common environmental hazards in Sri Lanka. However, their medical importance has not been fully evaluated yet. This study aims to study the burden, epidemiology, and outcome of stings and bites in primary hospitals in the Kurunegala district in North Western Province (NWP) of Sri Lanka. METHODOLOGY: The study was conducted one year from 25th May 2013 to 25th May 2014. Details of all stings and bites admissions and their outcomes were retrospectively extracted from hospital records in all 44 primary hospitals in the district...
March 6, 2018: Clinical Toxicology
Michael McGee, Nicholas Whitehead, Jennifer Martin, Nicholas Collins
INTRODUCTION: While pulmonary arterial hypertension remains an uncommon diagnosis, various therapeutic agents are recognized as important associations. These agents are typically categorized into "definite", "likely", "possible", or "unlikely" to cause pulmonary arterial hypertension, based on the strength of evidence. OBJECTIVE: This review will focus on those therapeutic agents where there is sufficient literature to adequately comment on the role of the agent in the pathogenesis of pulmonary arterial hypertension...
March 6, 2018: Clinical Toxicology
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